HomeMy WebLinkAboutCLE200900013 Legacy Document 2012-08-22a °t nL°er,
A plication for Zonin Clearance '
p CLE #
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OFFICE USE ON Y
PLEAZoning Clearance = $35 Check # % 7 Date:
REVIEW ALL 3 SHEETS Receipt # Staff:
PARCEL INFORMATION ter—
Existing Zoning
Tax Map and Parcel: %(e .� /d � C/ Pare/
g g
Parcel Owner:
,/!� State (A Zip 9-A 93
Parcel Address: �P �(�. �C Ile- Q/ ,i c city e
(include suite or fir)
PRIMARY CONTACT dd
Who should we call /write concerning this project? 1 , /
� rya- City �YUm�c,a lQOt'•x'�`� State Viii- Zip z'Z�
Address : 0 C
Office Phone: 0 _= %��Cell # J `t'� Fax # E-mail t)xs i.., Y,2S r�G, �v►4r�, ct
APPLICANT INFORMATION
Check any that apply: Change of
of use Change of name _New business
Business Name /Type:
Previous Business on this site l j
Describe the proposed business including use, number of employees, number of shifts, avail parkiii gispGces, T her of
vehiflep,pnd any additional information that you can provide: 3
*This Clearance will only be
Clearance will be required.
on the parcel for
I hereby certify that I own or have the owner's
is true and accurate to the best of MY�Prled.
Signature
it is approved. If you change,
or move the use to a new
a new Gonumg
remission to use the space indicated on this application. I also certify that the information provided
I have read the conditions of approval, and�I /understand them, and that I will abide by them.
Printed
A PROV 17nFUKIVIA11U1N Denied
Approved as proposed [ ]Approved with conditions [ ]
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Date
Building Official j q
Zoning Official Date
Date
Other Official
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (43 Revised 04/28/08 Page 2 of 3
Intake to complete the following:
Y/N
is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /9ticre
Wil be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or ublic water.
If private well, provide Healt ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?
Y /DN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign pen-nit.
Permit #
Y/p
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: a/ 170
N
»tted as: �'✓
Under Section:
Supplementary regulatio s section:
Parking formula: I /MD
Required spaces:
Y/N
Items to be verified in the field:
Zoning to complete the following:
Prot
Y(
Est:
'n
ViolFist:
Y /
If so,
If: o
Varia a e:
Y /
SP's:
W11 ist:
If so List:
SDP's
Clearances:
Revised 04/28/08 Page 3 of 3